Join the ADA Northern Territory

Membership Application

Joining your professional association is a smart move. As a not-for-profit organisation led by dentists for dentists, our remit is to deliver value to members. From students just starting out, from early career to top of career, from practice owner to retiring in style, the ADA is here to support you on your journey through dentistry. 

Complete the form below to submit your application. For a schedule of membership fees, click here.


Personal details

Home address


Are you a registered specialist (or studying to be):

Practice details

Are you currently practising? :

Membership agreement

I consent that both the ADA branch and federal office may use the details I have provided to communicate with me in relation to my membership, services or for other reasons relating to the profession or the practise of dentistry. For more information, read our Privacy policy.

Find out more about the ADA NT member categories and fees

ADA Northern Territory Declaration

  • I am applying for membership of the Australian Dental Association Northern Territory Branch.
  • I agree to be bound by the association's Constitution.
  • I undertake to at all times uphold the professional and ethical obligations of membership.
  • I understand that application for membership also includes membership of ADA Inoorporated (the federal body) as set out in the ADA NT's Constitution.
Have you currently or in the past had a statutory complaint upheld against you?:
Has your registration to practise as a dentist in any jurisdiction ever been suspended, revoked or had any restrictions or conditions imposed?:
Have you ever had your membership of this association or any other similar organisation refused or terminated?:
I declare the information provided above is true and accurate at the time of submission.: